Monkeypox – Eastern Mediterranean Region (EMRO), Region of the Americas (PAHO), Western Pacific Region (WPRO), European Region (EURO) (June 10, 2022)

This Multi-Country Monkeypox Outbreak Information Bulletin is an update to the Information Bulletin published on 4 June and includes updated data, additional details on the clinical description of cases and recommendations for action to increasing safety at gatherings, and again provides a summary of WHO guidance, including on vaccination.

The epidemic in brief

Since 13 May 2022, cases of monkeypox have been reported to WHO in 28 Member States located in four WHO regions (Region of the Americas, European Region, Eastern Mediterranean Region and Western Pacific Region) where monkeypox is usually not present or has not been observed previously (Figure 1). In addition, since the beginning of the year, 1,536 suspected cases have been reported in eight countries in the WHO African Region, including 59 confirmed cases and 72 deaths.

As cases are routinely detected and deaths reported in some countries in the African Region, there is a need to better understand the sources and mechanisms of disease transmission and provide people with the information and support they need to protect themselves and others in various contexts.

Epidemiological investigations are in progress. However, most of the cases reported in countries that had not previously been affected by the disease were detected in sexual health services or other health services in primary or secondary health care establishments, in individuals who had traveled to countries in Europe and North America and not to countries where the presence of the virus is known. More research needs to be conducted in countries with a long history of the disease to understand current and new sources of infection.

The sudden and unexpected appearance of cases of monkeypox simultaneously in several regions, not directly linked to travel to countries with a long history of the disease, suggests that there may have been undetected transmission during several weeks or even longer.

WHO considers the overall global public health risk to be moderate, as this is the first time that numerous cases and clusters of cases of monkeypox have been reported simultaneously in multiple countries located in geographical areas of the WHO very disparate.

Description of the outbreak

As of 8 June, 1,285 laboratory-confirmed cases and one probable case have been reported to WHO from 28 countries in four WHO regions where monkeypox is not usually present or has not been observed previously. This represents an increase of 505 laboratory-confirmed cases since the last Information Bulletin published on June 4, 2022, in which 780 cases were reported. As of June 8, 2022, no deaths associated with monkeypox have been reported in these four regions.

The majority of confirmed cases in these regions (87%) are in the WHO European Region (1112 cases). Confirmed cases have also been reported in the Region of the Americas (153 cases), the Eastern Mediterranean Region (14 cases) and the Western Pacific Region (6 cases). Case counts fluctuate as new information is reported and made available daily and data is verified by WHO in accordance with the provisions of the International Health Regulations (IHR 2005) (see Table 1).

Confirmed monkeypox cases in the current outbreak present variable clinical pictures. Many affected individuals do not present with the classic clinical picture of monkeypox (fever and swollen lymph nodes followed by a rash concentrated on the face and extremities). Atypical characteristics have been described, including: the appearance of only a few lesions or even of a single lesion; the appearance of lesions in the genital, perineal or perianal area that do not spread further; the appearance of lesions at different stages of development (asynchronous); and the appearance of lesions before the onset of other symptoms, such as swollen lymph nodes, fever or feeling unwell. How the virus is transmitted during sex is still unknown. While it is known that monkeypox can be transmitted by close physical contact, it is not yet known exactly what role biological fluids such as semen and vaginal secretions play in the transmission of the virus.

The situation is changing and WHO expects more cases of monkeypox to be reported as surveillance expands to all countries and regions.

In addition to cases reported or identified in previously unaffected countries, WHO continues to receive updates on the status of ongoing outbreaks and new cases identified in countries[1] in the African Region through established surveillance mechanisms (including under the Integrated Disease Surveillance and Response Strategy). As of 8 June 2022, there were 1,536 suspected cases and 72 deaths since the beginning of the year in eight countries, including 59 cases which have been confirmed in six countries (Table 2). This now includes cases from Ghana, which had never previously reported cases in humans, although a 2003 outbreak of monkeypox in the United States was associated with small mammals imported from Ghana.

Given the case fatality rate observed in the African Region, there is a need to strengthen all elements of the response in the region, including but not limited to awareness raising, risk communication, surveillance, diagnosis, laboratory support, research and analysis. WHO is providing guidance to countries with a long history of monkeypox as well as previously unaffected countries, and has made case reporting forms available to them.

Public health action

WHO continues to encourage the sharing of information on monkeypox. Clinical and public health incident response plans have been put in place to coordinate efforts for comprehensive case and contact tracing, laboratory investigations, clinical management and case isolation and implementation. implementation of infection control measures. When possible, genomic sequencing of the deoxyribonucleic acid (DNA) of the virus is used. Several European countries (Germany, Belgium, Spain, Finland, France, Israel, Italy, Netherlands, Portugal, United Kingdom of Great Britain and Northern Ireland, Slovenia and Switzerland) and the United States of America published complete or partial genome sequences of the currently circulating monkeypox virus. Research is still in progress. However, according to preliminary data from polymerase chain reaction (PCR) tests, the monkeypox virus genomes that have been detected are those of the West African clade. Two types of vaccines (ACAM-2000 and MVA-BN) are used for prophylaxis in case contacts by some Member States. Other countries may hold stocks of other vaccines (eg LC16 vaccine).

Interim guidance on public awareness, surveillance, laboratory diagnostics and testing, case investigation and contact tracing, clinical management, infection control, vaccines and immunization, communication on risks and community mobilization have been published or are being developed to help Member States respond to the epidemic.

Source: World Health Organization

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